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super.ego

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So this morning I attended a seminar in which participants read and discussed Brightman's 1984 article, "Narcissistic Issues in the Training Experience of the Psychotherapist." During the seminar, I expressed annoyance and frustration with psychoanalytic literature, particularly its insistence on utilizing off-putting jargon (e.g., "good breast" / "bad breast") that only seems to further alienate psychoanalytic thinking from the clinical psychological community. I believe there is clinical merit to psychoanalytic theory, especially its modern manifestations, but wish it was presented in a more accessible manner.

Is psychoanalysis going to dig its own grave and die off? Is it possible to bridge the linguistic divide, which mostly seems to be the doing of psychoanalysts themselves, between psychoanalysis and other theoretical orientations (or perhaps inter-theoretical animosity is more deep-seated than linguistics and jargon)? Anyway, I just wanted to put some ideas out there for the SDN community.

I think the field is shying away from inter-theoretical animosity. Starting in ~1930, people began to theorize about common factors that influence therapy. Now that it's 2017, there's a fairly convincing body of literature on it. If you haven't yet, check out the research on common factors, as well as "transdiagnostic psychotherapy".
 
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I've read research on common factors, but I hadn't heard of transdiagnostic psychotherapy before you mentioned it. I just did some Google searches and it seems
fascinating. Thank you!

What are your thoughts on the sustainability of psychoanalysis proper?

Short-term psychodynamic approaches do have some merit and promise. However, psychoanalysis proper is a different story, as not only must it contend with research/evidence base issues but there is also the whole economical problem as well.
 
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I'd argue classical analysis IS effectively dead. There are a handful of pockets and holdouts, comprised almost exclusively of folks nearing or past retirement age. I've met a grand total of 1 early career psychologist interested in classical analysis. I cant think of more than a handful of universities with an analyst on faculty, which limits it's influence on the up and coming generations. It's basically a dead tree that just hasn't fallen yet. And yes, I do think that death was largely a suicide. At least a slow, passive one through decades of continuing to chain smoke while scarfing nachos and never getting off the couch, despite repeated urging by damn near everyone to at least try and take steps to take care of itself.

As others have said though, contemporary psychodynamic treatments are another matter. Some do have an evidence base and they have supporters who seem at least somewhat less egotistical, more grounded in reality and are willing to put in the work to keep things moving forward. Evidence is still shaky or non-existent for many common presenting problems, but it's a start.

This is really the natural evolution of fields though (or at least should be). We are health providers, not historians. Traditional Beck-style CBT is also slowly starting to fade beneath 3rd wave treatments and evidence that the cognitive components do not provide added benefit in some circumstances. It's certainly in far better shape than analysis right now (for many reasons), but we will see what the future holds.
 
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Just some opinions:

IMO, psychology can be divided into two gross conceptual ideas (for this purpose): treating pathology and self knowledge/improvement. Psychoanalysis is a pretty clumsy and likely ineffective tool for treating pathology. If you suffer from MDD, a 16 week course of CBT and sertraline is going to be easier, cheaper, and more effective than a 3X/week course of psychoanalysis which insurance isn't going to pay for. However, there remain problems of living which are not described by the DSM5. If one wants to understand interpersonal behavioral patterns, hopes, dreams, expectations of self and others, etc, psychoanalysis is not a bad tool. But it is not the only tool.

There are some impracticalities with the technique: At 3hrs/week, for 3-5 years, there are many people who will not be able to engage in this process because of the increasing demands on the American worker, stagnant rates of real income, parental norms, etc. Because there are more effective, cheaper, and less time intensive treatments, insurance will not pay. So an analyst needs a group of people who have the education to be familiar with psychoanalysis as it's own training, have the time to tie up 3/hrs a week during the middle of the day, have the cash to pay for 3 sessions/week (let's say $300/week, or $1200/month) and doesn't want to put that money into a beach house/stock account/fancy car, etc. It's a small group.

Another part of the problem with psychoanalysis is that it is not really a theory so much as a general method. The ego psychologist would believe that one thing is the cause of something, while the self psychologists/freudians/winnicottians/Lacanians/interpersonal psychologists/etc would think another. Throw the idea of "good breast" at a Kohutian, and you're in for a long and boring discussion. I believe that there is utility in the method, but there is probably a behavioral explanation for the method which is better. There's been plenty written about that, and some resurgence in more recent(ish) history.
 
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You'll find niches on the coasts, higher concentration on the East Coast. Also, small pockets anywhere you have a large concentration of people with large amounts of disposable income who want to blame someone else for their problems.
 
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I live in DC and there seems to be a niche market for psychoanalysis here (I've met about five analysts). I would imagine the same applies to New York City and other East Coast cities.

Yes, most any large city with a thriving socioeconomic top tier will have some sort of market for psychoanalysis.
 
Psychoanalysis, psychodynamic psychotherapy, and psychoanalytic PSYCHOLOGY are alive and well. I'm heading to the Division 39 Conference this week, and am very much looking forward to it!

Division of Psychoanalysis: 37th Annual Spring Meeting

Also, describing psychoanalysis (especially in its contemporary forms) as " blame(ing) someone else for their problems" is a pretty gross mischaracterization.
 
Yes, I'm well aware of Division 39 (I'm a member) and the upcoming Spring Meeting in New York (I know many individuals who will be presenting). Also, I agree that "patient blaming" is an outdated characterization of psychoanalysis, especially in light of modern relational psychoanalytic theories (e.g., intersubjectivity). That said, it's no secret that psychoanalysts are not doing a great job of making psychoanalytic thinking accessible and/or relevant to theorists and clinicians of different training backgrounds, which I consider quite tragic.

In fact, "Only 15 percent of members in the American Psychoanalytic Association are under 50" (How psychoanalysts are fighting to make their profession relevant). If that trend is accurate, the future of psychoanalysis is bleak at best.


I don't disagree with you, re: making psychoanalytic thinking accessible/relevant. I think there are some excellent exceptions, like Paul Wachtel (integrating behaviorism/learning theory + psycho-a), Fonagy's work on delineating treatment manuals using relational psychoanalysis in the NHS, Jaques Barber and Richard Summers recent work, the growing ISTDP rct literature for a variety of disorders. . . etc etc. Im sure you know many more examples too.
 
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Just pulled the numbers since I was curious. Over half of division 39 members are past normal retirement age and around 70% are over 60. Most divisions are top heavy, but that was the most extreme of the ones I checked.

Division Profiles by Division
 
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